BILL NUMBER: AB 271	CHAPTERED  10/10/99

	CHAPTER   944
	FILED WITH SECRETARY OF STATE   OCTOBER 10, 1999
	APPROVED BY GOVERNOR   OCTOBER 10, 1999
	PASSED THE ASSEMBLY   SEPTEMBER 10, 1999
	PASSED THE SENATE   SEPTEMBER 8, 1999
	AMENDED IN SENATE   SEPTEMBER 3, 1999
	AMENDED IN SENATE   AUGUST 25, 1999
	AMENDED IN SENATE   JULY 1, 1999
	AMENDED IN SENATE   JUNE 23, 1999
	AMENDED IN ASSEMBLY   MAY 6, 1999
	AMENDED IN ASSEMBLY   MARCH 17, 1999

INTRODUCED BY   Assembly Member Gallegos

                        FEBRUARY 3, 1999

   An act to add Sections 2216.1, 2216.2, and 2240 to the Business
and Professions Code, and to amend Section 1248.15 of the Health and
Safety Code, relating to medical care.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 271, Gallegos.  Health care.
   Existing law requires reports regarding personal injury judgments
and settlements involving health care providers, and other reports of
possible incompetence by health care providers.
   This bill would enact the Cosmetic and Outpatient Surgery Patient
Protection Act.  This act would require any physician and surgeon who
performs a scheduled medical procedure outside of a general acute
care hospital that results in the death or transfer to a hospital or
emergency center for medical treatment for a period exceeding 24
hours, of any patient on whom that medical treatment was performed by
the physician and surgeon, or by a person acting under the physician
and surgeon's orders or supervision, to report, in writing, that
occurrence to the Medical Board of California within 15 days after
the occurrence, as specified.  It would provide that the failure to
comply with this requirement constitutes unprofessional conduct.
   The bill would also provide that, on and after July 1, 2000, it is
unprofessional conduct for a physician and surgeon to perform
procedures in any outpatient setting unless the setting has a minimum
of 2 staff persons on the premises, one of whom is either a licensed
physician and surgeon or a licensed health care professional with
current certification in advanced cardiac life support, as long as a
patient is present who has not been discharged from supervised care.
It would further provide that it is unprofessional conduct for a
physician and surgeon to fail to provide adequate security by
liability insurance or by participation in an interindemnity trust
for claims by patients arising out of surgical procedures performed
outside of a general acute care hospital.
   Existing law provides for the licensure and regulation of health
facilities.  Existing law provides for the accreditation of
outpatient facilities subject to the supervision of the Division of
Licensing of the Medical Board of California.  Existing law regulates
those facilities. Existing law requires outpatient facilities to
submit an emergency plan to accrediting agencies.
   This bill would require outpatient settings to post the
certificate of accreditation in a location readily visible to
patients and staff, and to post the name and telephone number of the
accrediting agency with instructions on the submission of complaints
in a location readily visible to patients and staff.  It would
require outpatient settings to have a written discharge criteria.
   The bill would also require outpatient settings to have a minimum
of 2 staff persons on the premises, one of whom shall be either a
licensed physician and surgeon or a licensed health care professional
with current certification in advanced cardiac life support, as long
as a patient is present who has not been discharged from supervised
care.  It would provide that transfer to an unlicensed setting of a
patient who does not meet the discharge criteria shall constitute
unprofessional conduct.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  This act shall be known and may be cited as the
Cosmetic and Outpatient Surgery Patient Protection Act.
  SEC. 2.  Section 2216.1 is added to the Business and Professions
Code, to read:
   2216.1.  On and after July 1, 2000, it is unprofessional conduct
for a physician and surgeon to perform procedures in any outpatient
setting except in compliance with Section 2216, unless the setting
has a minimum of two staff persons on the premises, one of whom shall
either be a licensed physician and surgeon or a licensed health care
professional with current certification in advanced cardiac life
support (ACLS), as long as a patient is present who has not been
discharged from supervised care.
  SEC. 3.  Section 2216.2 is added to the Business and Professions
Code, to read:
   2216.2.  (a) It is unprofessional conduct for a physician and
surgeon to fail to provide adequate security by liability insurance,
or by participation in an interindemnity trust, for claims by
patients arising out of surgical procedures performed outside of a
general acute care hospital as defined in subdivision (a) of Section
1250 of the Health and Safety Code.
   (b) For purposes of this section, the board shall determine what
constitutes adequate security.
   (c) Nothing in this section shall require an insurer admitted to
transact liability insurance in this state to provide coverage to a
physician and surgeon.
   (d) The security required by this section shall be acceptable only
if provided by any one of the following:
   (1) An insurer admitted pursuant to Section 700 of the Insurance
Code to transact liability insurance in this state.
   (2) An insurer that appears on the list of eligible surplus line
insurers pursuant to subdivision (f) of Section 1765.1 of the
Insurance Code.
   (3) A cooperative corporation authorized by Section 1280.7 of the
Insurance Code.
  SEC. 4.  Section 2240 is added to the Business and Professions
Code, to read:
   2240.  (a) Any physician and surgeon who performs a scheduled
medical procedure outside of a general acute care hospital, as
defined in subdivision (a) of Section 1250 of the Health and Safety
Code, that results in the death of any patient on whom that medical
treatment was performed by the physician and surgeon, or by a person
acting under the physician and surgeon's orders or supervision, shall
report, in writing on a form prescribed by the board, that
occurrence to the board within 15 days after the occurrence.
   (b) Any physician and surgeon who performs a scheduled medical
procedure outside of a general acute care hospital, as defined in
subdivision (a) of Section 1250 of the Health and Safety Code, that
results in the transfer to a hospital or emergency center for medical
treatment for a period exceeding 24 hours, of any patient on whom
that medical treatment was performed by the physician and surgeon, or
by a person acting under the physician and surgeon's orders or
supervision, shall report, in writing, on a form prescribed by the
board that occurrence, within 15 days after the occurrence.  The form
shall contain all of the following information:
   (1) Name of the patient's physician in the outpatient setting.
   (2) Name of the physician with hospital privileges.
   (3) Name of the patient and patient identifying information.
   (4) Name of the hospital or emergency center where the patient was
transferred.
   (5) Type of outpatient procedures being performed.
   (6) Events triggering the transfer.
   (7) Duration of the hospital stay.
   (8) Final disposition or status, if not released from the
hospital, of the patient.
   (9) Physician's practice specialty and ABMS certification, if
applicable.
   (c) The form described in subdivision (b) shall be constructed in
a format to enable the physician and surgeon to transmit the
information in paragraphs (5) to (9), inclusive, to the board in a
manner that the physician and surgeon and the patient are anonymous
and their identifying information is not transmitted to the board.
The entire form containing information described in paragraphs (1) to
(9), inclusive, shall be placed in the patient's medical record.
   (d) The board shall aggregate the data and publish an annual
report on the information collected pursuant to subdivisions (a) and
(b).
   (e) On and after January 1, 2002, the data required in subdivision
(b) shall be sent to the Office of Statewide Health Planning and
Development (OSHPD) instead of the board.  OSHPD may revise the
reporting requirements to fit state and national standards, as
applicable.  The board shall work with OSHPD in developing the
reporting mechanism to satisfy the data collection requirements of
this section.
   (f) The failure to comply with this section constitutes
unprofessional conduct.
  SEC. 5.  Section 1248.15 of the Health and Safety Code is amended
to read:
   1248.15.  (a) The division shall adopt standards for accreditation
and, in approving accreditation agencies to perform accreditation of
outpatient settings, shall ensure that the certification program
shall, at a minimum, include standards for the following aspects of
the settings' operations:
   (1) Outpatient setting allied health staff shall be licensed or
certified to the extent required by state or federal law.
   (2) (A) Outpatient settings shall have a system for facility
safety and emergency training requirements.
   (B) There shall be onsite equipment, medication, and trained
personnel to facilitate handling of services sought or provided and
to facilitate handling of any medical emergency that may arise in
connection with services sought or provided.
   (C) In order for procedures to be performed in an outpatient
setting as defined in Section 1248, the outpatient setting shall do
one of the following:
   (i) Have a written transfer agreement with a local accredited or
licensed acute care hospital, approved by the facility's medical
staff.
   (ii) Permit surgery only by a licensee who has admitting
privileges at a local accredited or licensed acute care hospital,
with the exception that licensees who may be precluded from having
admitting privileges by their professional classification or other
administrative limitations, shall have a written transfer agreement
with licensees who have admitting privileges at local accredited or
licensed acute care hospitals.
   (iii) Submit for approval by an accrediting agency a detailed
procedural plan for handling medical emergencies that shall be
reviewed at the time of accreditation.  No reasonable plan shall be
disapproved by the accrediting agency.
   (D) All physicians and surgeons transferring patients from an
outpatient setting shall agree to cooperate with the medical staff
peer review process on the transferred case, the results of which
shall be referred back to the outpatient setting, if deemed
appropriate by the medical staff peer review committee.  If the
medical staff of the acute care facility determines that
inappropriate care was delivered at the outpatient setting, the acute
care facility's peer review outcome shall be reported, as
appropriate, to the accrediting body, the Health Care Financing
Administration, the State Department of Health Services, and the
appropriate licensing authority.
   (3) The outpatient setting shall permit surgery by a dentist
acting within his or her scope of practice under Chapter 4
(commencing with Section 1600) of the Business and Professions Code
or physician and surgeon, osteopathic physician and surgeon, or
podiatrist acting within his or her scope of practice under Chapter 5
(commencing with Section 2000) of the Business and Professions Code
or the Osteopathic Initiative Act.  The outpatient setting may, in
its discretion, permit anesthesia service by a certified registered
nurse anesthetist acting within his or her scope of practice under
Article 7 (commencing with Section 2825) of Chapter 6 of the Business
and Professions Code.
   (4) Outpatient settings shall have a system for maintaining
clinical records.
   (5) Outpatient settings shall have a system for patient care and
monitoring procedures.
   (6) (A) Outpatient settings shall have a system for quality
assessment and improvement.
   (B) Members of the medical staff and other practitioners who are
granted clinical privileges shall be professionally qualified and
appropriately credentialed for the performance of privileges granted.
  The outpatient setting shall grant privileges in accordance with
recommendations from qualified health professionals, and
credentialing standards established by the outpatient setting.
   (C) Clinical privileges shall be periodically reappraised by the
outpatient setting.  The scope of procedures performed in the
outpatient setting shall be periodically reviewed and amended as
appropriate.
   (7) Outpatient settings regulated by this chapter that have
multiple service locations governed by the same standards may elect
to have all service sites surveyed on any accreditation survey.
Organizations that do not elect to have all sites surveyed shall have
a sample, not to exceed 20 percent of all service sites, surveyed.
The actual sample size shall be determined by the division.  The
accreditation agency shall determine the location of the sites to be
surveyed.  Outpatient settings that have five or fewer sites shall
have at least one site surveyed.  When an organization that elects to
have a sample of sites surveyed is approved for accreditation, all
of the organizations' sites shall be automatically accredited.
   (8) Outpatient settings shall post the certificate of
accreditation in a location readily visible to patients and staff.
   (9) Outpatient settings shall post the name and telephone number
of the accrediting agency with instructions on the submission of
complaints in a location readily visible to patients and staff.
   (10) Outpatient settings shall have a written discharge criteria.

   (b) Outpatient settings shall have a minimum of two staff persons
on the premises, one of whom shall either be a licensed physician and
surgeon or a licensed health care professional with current
certification in advanced cardiac life support (ACLS), as long as a
patient is present who has not been discharged from supervised care.
Transfer to an unlicensed setting of a patient who does not meet the
discharge criteria adopted pursuant to paragraph (10) of subdivision
(a) shall constitute unprofessional conduct.
   (c) An accreditation agency may include additional standards in
its determination to accredit outpatient settings if these are
approved by the division to protect the public health and safety.
   (d) No accreditation standard adopted or approved by the division,
and no standard included in any certification program of any
accreditation agency approved by the division, shall serve to limit
the ability of any allied health care practitioner to provide
services within his or her full scope of practice.  Notwithstanding
this or any other provision of law, each outpatient setting may limit
the privileges, or determine the privileges, within the appropriate
scope of practice, that will be afforded to physicians and allied
health care practitioners who practice at the facility, in accordance
with credentialing standards established by the outpatient setting
in compliance with this chapter.  Privileges may not be arbitrarily
restricted based on category of licensure.
